Wednesday, March 14, 2012
QD: News Every Day--iPads make residents more efficient on rounds
Internal medicine residents have limited work hours for their work duties, so every minute spent on paperwork comes at the expense of direct patient care or education. Residents at the University of Chicago internal medicine service, like other programs around the country, applied iPads to see if they could boost resident workflow efficiency and patient care.
Resident Nancy Luo, MD, ACP Associate Member, wrote to Steve Jobs directly, and got the response the next day. Jobs directed an Apple marketing manager to visit the hospital for follow-up.
The iPads were password-protected. They could access to the hospital's wireless network but did not store records. Apps include access to medical journals and a clinical calculator, and links were required for PubMed, the hospital paging directory, journal club, a scheduling tool and a list of discount drug prices.
115 residents received iPads and were surveyed about their habits and self-perceived efficiency one month before and four months after receiving them. The electronic health record marked the time frame of all patient care orders placed in the first 24 hours of a new patient's admission from January to March 2011. These data were compared with the time frame for orders during patient admission in the same three-month period in 2010 to seek any change in ordering efficiency.
The rate of patient orders per admission by admission hour was compared for both groups. Results appeared in a research letter in the March 12 issue of Archives of Internal Medicine.
Almost 90% of residents (100) used their iPad for clinical duties, with almost 75% (72) using their iPad every day. 78% reported being more efficient on the wards, with a self-reported time savings of about an hour a day.
56% felt that they could attend more conferences by using their iPads. 68% percent of all housestaff reported averting patient care delays. Study authors wrote, "Interestingly, interns were more likely than residents to report that the iPad improved their efficiency on the wards (89% of interns vs. 71% of residents; P=.03)."
From January to March of 2010 and 2011, there were 631 and 675 general medicine admissions, which generated 16,770 and 17,414 total orders placed in the first 24 hours of admission, respectively. There was no difference (P=.58) in the number of orders per admission in 2010 before iPads (27 orders per admission) and 2011 after iPads (26 orders per admission).
The timing of orders changed after iPads arrived. Specifically, 5% more orders were placed prior to postcall attending rounds, and there were 8% more orders placed prior to the time at which postcall teams are scheduled to leave the hospital. More orders were placed prior to postcall attending rounds (33% precall vs. 38% postcall; P less than .001) and before departure of postcall team (56% precall vs. 64% postcall; P less than .001). There were also more orders placed in the first two hours of admission (odds ratio, 1.06; 95% confidence interval, 1 to 1.12; P=.04) in 2011 with iPads than in 2010 without them.
"We were encouraged to see that this technology could enhance patient care in the setting of restricted resident duty hours," said chief resident Christopher Chapman, MD, ACP Associate Member.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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